Concerns raised over safe discharges as health bosses pledge to learn from mistakes

Concerns were raised this week over anecdotal reports about the risk to vulnerable people through discharge from hospitals without Covid-secure measures being taken.

Councillors sitting on an influential committee scrutinising health matters in Hackney, Newham, Tower Hamlets and the City of London challenged NHS bosses on cases involving patients being sent home without a clear Covid diagnosis, or without notification, from Covid-positive wards.

Cllr Peter Snell, who is also chair of trustees of DABD UK, a charity which provides services to enable people to live independently, called for the proper sharing of information when system failures allow people to be discharged without adequate protection into situations in which they could infect others with Covid.

Snell said: “The whole principle of the NHS is that we learn from mistakes. It’s a no-blame culture and we just get on with it. I’m not going to go into details of the poor client we had with cystic fibrosis who was discharged from hospital with Covid-19. We only knew to check on him because the ambulance driver told us.

“What is happening across this whole region to monitor discharges that have then put other people at risk and where there have been failings in the system so that we can all learn from each other? We can protest about discharges into care homes on behalf of our clients, but what is happening for discharges into home circumstances where the tests have not been followed and how do we make sure that that happens in future?

“The ambulance driver told us he had just come from a ward with a Covid patient. That should never happen, so come on – let’s learn from each other.”

Waltham Forest councillor Richard Sweden also said that he had heard anecdotal reports of people being discharged home with positive diagnoses to vulnerable spouses who could be aged over 80, adding that the issue was “something that should be looked at”.

Responding to councillors’ questioning, Jane Milligan, who is accountable officer of Newham clinical commissioning group, underlined that the health system brings together multi-agency groups of social workers, GPs, acute and community staff in which professionals share good practice and can learn from mistakes.

Directors of adult social services are also understood to meet on a weekly basis to feed in information on these issues, as well as safeguarding leads for adults and children, making sure that a measure of “quality oversight on all kinds of different levels” is provided, according to Milligan, who urged councillors listening to share instances of where things had gone wrong.

David Maher, managing director at City & Hackney CCG, said that to his knowledge the health system had not experienced “vast numbers” of incidents of the type described by Sweden.

Since April, the NHS has had responsibility for testing any patient discharged from hospital to a care home, with the patient needing to be isolated in the same way as a Covid-positive patient pending the result.

In order for tests to not hold up discharging, they are planned up to 48 hours ahead of schedule, with the information from the test as well as supporting care information to be communicated to the relevant care home.

Heather Noble, medical director at Barts Health NHS Trust, said: “We know that we need to do a test on people within 48 hours of discharge if they are going to anywhere in any residential accommodation, and they are not let out the door unless that is the case. We have to share that result with their destination.

“We also tell people themselves and their families if they are going home to a family or to their residential home and their carers if they are going to be providing a package if there is any chance that that person may be at risk of becoming Covid-positive or has been on a Covid-positive ward. We have really clear checks on that.

“We have a complex discharge team who have a system of checks that are put in place to make sure that nothing is missed out and we review our compliance with all of this on a regular basis, so we do have good systems in place. We do aim to inform everybody and if we have missed it on occasions, then we do need to learn from that, absolutely.”